Strengthening Families So Young Children Thrive:

Evaluation Findings from a Zambian Early Childhood Development Program for Children Affected by HIV/AIDS

A Community-Led, Holistic Approach

KEY FINDINGSPROGRAM STRATEGY

CONCLUSIONSEVALUATION METHODOLOGY

GOAL: Strengthen parents’ and other primary caregivers’ nurturing care and early stimulation of their young children, while supporting vulnerable families to improve their health, nutrition and livelihoods.

ECD VOLUNTEERS WERE EFFECTIVE CHANGE AGENTS

Gained sound knowledge of ECD and parenting practices

Acquired facilitation and social and behavior change communication skills

Worked effectively with primary caregivers:

Developed trusted relationships

Promoted adoption of parenting practices

Provided psychosocial support

Made referrals and linked families to needed services

CHANGED ATTITUDES AND BEHAVIOR: FATHERS’ ROLE IN PARENTING Fathers reported new understanding of the importance of men taking an active role in care and nurturance

Fathers’ increased their interaction with children by:

Talking, storytelling and playing with children

Helping take care of children

Taking children to growth monitoring and health services

IMPROVED HEALTH, NUTRITION AND LIVELIHOODS

Increased health and nutrition knowledge and practices by primary caregiver which led to improved child health and nutrition

Increased economic strengthening through formation of caregiver-run savings & loan groups and development of social funds to assist members with emergency needs

Increased frequency and duration of intentional parent-child interaction

Caregivers in the ECD Program spend 50% more time interacting with their children each day than caregivers in the control group

THEORY OF CHANGE

INCREASED NURTURING CARE AND STIMULATION

PICTURE-BASED DIALOGUES CHANGED PARENTING BEHAVIORS

During home visits and peer group meetings, volunteers used the Essential Package Visual Guides—Critical Needs and Actions for Young Children and for Caregivers and a parenting skills manual’s picture cards

Primary caregivers cited volunteers’ use of pictures as giving them a better understanding of critical parenting actions and motivating them to try new practices

COMBINATION OF ECD HOME VISITS AND PEER GROUPS PROVIDED REINFORCING BENEFITS

HOME VISITSPrimary caregivers received one-on-one attention for their particular issues in a confidential setting

PRIMARY CAREGIVER SUPPORT & LEARNING GROUPSPrimary caregivers gained new information, learned from others’ questions, shared how they solved common parenting problems, positively influenced each other to practice what they learned and provided mutual support

REDUCED STIGMA AROUND HIV/AIDS AND INCREASED HIV TESTING

Increased knowledge of HIV prevention and transmissionCaregivers cited changes in attitudes that destigmatized HIV and encouraged testing

Improved care for children whose parents had died of HIV/AIDS after people understood how HIV/AIDS is transmitted

Trusted relationships through peer groups and home visits contributed to increase in parents/primary caregivers coming forward for HIV testing and treatment, if positive

ECD PROGRAM

6,228

Families

9,936 Children Under 5 Under 3

53 7

Rural Communities Provinces

53 ECD Management Committees Oversaw volunteers and coordinated project activities and

services provided by other stakeholders

742 ECD VolunteersFacilitated monthly: Home Visits Primary Caregiver Support & Learning Groups Children’s Playgroups

MIXED METHODS: Quantitative and qualitative

SAMPLING METHOD: Multi-stage, non-random sampling with probability proportionate to size

STUDY PARTICIPANTS: primary caregivers, ECD volunteers, staff

LONGITUDINAL SURVEY: 2014-2016

QUASI-EXPERIMENTAL DESIGN: comparing outcomes between program participants and unexposed primary caregivers with a similar profile (simple control group)

PARENTING EMPOWERMENT The program had a significant impact in strengthening parent-child relationships and interactions, thereby improving the development of the most vulnerable young children.

COMMUNITY OWNERSHIP AND NETWORKS

The strong sense of community ownership, leadership committee structures and extensive network of multi-sectoral stakeholders created a solid basis for sustainability.

PROGRAM REPLICABILITY

The program provides an integrated, cost-effective model replicable in other rural settings in Africa with similar demographic characteristics. The model should be scaled up to provide equitable access to improving child development outcomes, particularly for children affected by HIV and other vulnerabilities.

49% Participating families affected by HIV/AIDS

67%

642 TotalSampleSize

Increased quality of interaction

BEFORE: Less than 50% of children were engaged with caregivers in these activities

AFTER: 80% of children engaged with caregivers in these activities

30%I N C R E A S E

n Baseline 2014 n Endline 2016 n Control

Children and Caregivers Engaging in Activities by Developmental Areas

n Average Baseline n Average Endline n Average Control

COGNITIVE38%79%39%

LANGUAGE49%80%49%

MOTOR SKILLS 43%79%43%

SOCIAL 75%92%78%

EMOTIONAL 71%84%65%

AREA FOR STRENGTHENING Primary caregivers increased their use of positive discipline practices. However, corporal punishment needs to be further reduced and the program will intensify focus on this.

External program evaluation conducted by Dr. Beatrice Matafwali and Matthias Zingel

Poster AuthorsAbiy Seifu, Dawn Murdock and Chou Nuon Episcopal Relief & DevelopmentFelicia Sakala, Zambia Anglican Council Outreach Programmes

ReferenceEssential Package: Holistically Addressing the Needs of Young Vulnerable Children and Their Caregivers Affected by HIV/AIDS is a resource developed by the Inter-Agency Task Force on ECD and AIDS within the Consultative Group on Early Childhood Care and Development.

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Largest impact in cognitive, language and motor skills development activities

Social and emotional development activities were higher at baseline but also increased significantly.

Primary caregivers reported immediate changes in their children’s behavior and development as a result of their new parenting practices

Caregivers were motivated to continue and share what they learned with neighbors

We have learnt that talking to our children is important. In the past, we just used to leave children on their own. We now tell stories to our children, we sing to them and we play with them because we understand that even before the child goes to grade one they are supposed to learn.”

—MALE CAREGIVER

Communities mobilize

to support ECD with

vulnerable families

ECD volunteers

facilitate peer learning and support for parenting behavior change

Primary caregivers are healthy and able to respond to children’s

needs

Families connect to

services and opportunities to meet basic

needs

Childrenreachtheir full

developmentalpotential

45%55%

Cognitive DevelopmentChild/Caregiver Interactions

PROVIDED PLAY MATERIAL 24% 85% 38%

PLAYED COUNTING GAMES21%86%

50%

ASKED CHILD WHAT HE/SHE IS DOING 63% 88% 51%

TOOK CHILD OUTSIDE HOUSEHOLD 44% 58% 18%

Language DevelopmentChild/Caregiver Interactions

SINGING WITH/TO CHILD56%88%59%

TELLING CHILD A STORY41%80%48%

ENCOURAGING CHILD TO TELL A STORY55%76%45%

EXPLAINING WHAT CAREGIVER IS DOING 45%76%51%

Motor SkillsChild/Caregiver Interactions

PROVIDING SMALL OBJECTS TO PICK UP42%76%36%

STACKING STICKS FOR DRAWING IN SAND/DIRT36%91%79%

ENCOURAGING CHILD TO JUMP, DANCE, KICK BALL

56%94%65%